Organization
EVERGREEN THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY DARREN MATSUO PEDERSON OTR (OWNER)
(303) 579-0322
Entity
Organization
Contact information
Practice address
601 GRIFFIN PL, APT A, FORT COLLINS, CO 80521-1896
(303) 579-0322
Mailing address
601 GRIFFIN PL, APT A, FORT COLLINS, CO 80521-1896
(303) 579-0322
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3123
CO
Other
Enumeration date
05/08/2013
Last updated
05/08/2013
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